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Caesarean Section Core Operative Page

Caesarean Section Core Operative Page operating theatre - obstetric
IN REVIEWPENDING CLINICAL VERIFICATION
Indications
  • See lscs module urgency framework
Consent points
  • Specific injury/transfusion/hysterectomy/future-placenta risks
  • Skin-to-skin plans where feasible
Equipment
  • Standard CS tray; head-elevation vacuum for impacted head; cell-salvage availability
Anaesthesia
  • Regional default; GA criteria list

Preparation

  • Antibiotic timing chart; neonatal team; VTE stockings; warming blanket
Procedure steps
  1. Joel-Cohen/transverse skin incision
  2. Blunt abdominal entry; bladder flap as needed
  3. Lower-segment transverse hysterotomy (avoid placenta!)
  4. Deliver head/body; cord gases
  5. Oxytocin bolus+infusion; controlled placental delivery
  6. Single-layer uterine closure; check ovaries/tubes opportunistically
  7. Counts -> layered closure; subcuticular skin
Troubleshooting:
  • Impacted head: elevation device/push-from-below
  • Praevia encountered: pas-spectrum rules
  • Angle tears: visualise ureters; extend deliberately
Complications & management
PPH

Uterotonics -> balloon/compression sutures ladder

Bladder injury

Two-layer urology repair + catheter 7-14 days

Endometritis

Triple antibiotics; wound review

Postoperative care

  • ERAS bundle: early fluids/feeding/mobilisation
  • Multimodal analgesia incl. TAP blocks

Admission & discharge

Care setting: Planned or emergency inpatient surgery

Admission/discharge guidance checked 2026-10-18 against the linked sources. This is a clinical checklist for an individual decision, not an automatic discharge order.

When admission or continued hospital care is needed

  • Admit for the planned operation or for any urgent maternal/fetal indication. Haemorrhage, sepsis, instability or organ-support needs require increased monitoring/critical care.

When clinic, day care or home care may be suitable

  • A caesarean operation requires a maternity surgical setting; antenatal planning may be outpatient until the admission date if no complication requires earlier care.

Before going home

  • Afebrile and recovering well, with no unresolved operative/anaesthetic complication, concerning bleeding or respiratory issue; pain is controlled on an oral plan and oral intake/mobility are adequate.
  • The urinary catheter has been removed with satisfactory bladder assessment, or a named catheter/voiding-trial plan is provided. Wound, VTE risk and maternal/newborn discharge needs are reviewed.
  • NICE UK offers discharge after 24 hours only for selected uncomplicated recovery with home follow-up. This is not an automatic Indian postoperative discharge time; use local service policy and individual surgical readiness.

Discharge medicines and treatment changes

  • Use a defined oral analgesic plan: paracetamol plus ibuprofen if suitable, reducing/stopping as pain improves. Avoid codeine/co-codamol while breastfeeding.
  • Review the indication, dose and stop date for VTE prophylaxis; teach injections when prescribed. Antibiotic prophylaxis at surgery does not automatically justify a take-home antibiotic course.
Medicine doses — use only when indicated

Use the medicines selected for this patient. Listed alternatives are not instructions to prescribe all of them together. Confirm the actual remaining course, pregnancy/postnatal context and monitoring plan.

Baseline oral pain relief when prescribed.

Paracetamol (acetaminophen) — oral pain reliefMédecins Sans Frontières · Current online monographchecked
Dose1 g (two 500 mg tablets) per dose
RouteOral
FrequencyEvery 6–8 hours when needed; maximum 4 doses in 24 hours
DurationAccording to clinical response: reduce/stop as pain improves. Record the prescribed supply and review date; persistent or increasing pain needs reassessment rather than an automatic repeat course.
PreparationCheck tablet strength: two 500 mg tablets = 1 g. Count paracetamol in every combination/OTC product towards the total; this is not an IV preparation.
Max dose4 g in 24 hours for the stated adult population. Lower weight, hepatic impairment or other risk factors require an individual reduced prescription; do not automatically use this maximum.
  • Indication: Short-term maternal postoperative/postpartum pain or other mild pain after assessment; adult ≥50 kg
  • MSF oral monograph: no pregnancy or breastfeeding contraindication. The dose does not replace assessment of the cause of pain.
Monitoring
  • Pain and functional recovery; investigate increasing pain, fever or other warning symptoms.
  • Check all prescribed/OTC paracetamol, weight and hepatic risk; suspected excess dosing requires urgent assessment.
Contraindications: Paracetamol allergy; avoid duplicate paracetamol-containing products. · Hepatic impairment needs caution and a clinician-adjusted regimen. This adult ≥50 kg card is not a weight-based prescription for smaller adults or children.

Combine only when the clinician has excluded contraindications.

Ibuprofen — postpartum/nonpregnant postoperative painMédecins Sans Frontières · Current online monographchecked
Dose200–400 mg per dose
RouteOral
FrequencyEvery 8 hours when prescribed; reduce/stop as symptoms improve
DurationShortest course needed for recovery; MSF postoperative reference maximum 8 days. Record the actual stop/review date; ongoing or increasing pain needs clinical review.
PreparationCheck 200 mg or 400 mg tablet strength. Take with food; do not combine with another NSAID or duplicate OTC ibuprofen.
Max dose1,200 mg in 24 hours in this pain regimen; do not import higher anti-inflammatory schedules into a discharge prescription.
  • Indication: Short-term pain relief after birth or gynaecological surgery when NSAIDs are appropriate; not an antenatal regimen
  • Short-term use is compatible with breastfeeding in the MSF reference. Do not prescribe while bleeding or renal contraindications remain unresolved.
Monitoring
  • Pain response, hydration/urine output, GI pain or bleeding; review renal function when clinically indicated.
  • Check current bleeding, renal/hepatic function, allergy/asthma history, anticoagulants and interacting medicines before prescribing.
Contraindications: NSAID allergy or NSAID-triggered asthma; active peptic ulcer/GI bleeding or a significant bleeding/coagulation problem. · Severe renal/hepatic impairment, severe heart failure, uncorrected dehydration/hypovolaemia or severe infection. Avoid in OHSS because of renal risk. · Avoid concurrent NSAIDs; anticoagulants, methotrexate, ACE inhibitors/diuretics and other interacting medicines require prescriber review. This card is for postpartum/nonpregnant care, not pregnancy.

Tests, pending results and their reviewer

  • Arrange repeat CBC/other tests after major blood loss or abnormal findings and identify who acts on the result. Assign pathology review when tissue was sent.

Home care and counselling

  • Explain wound hygiene, suture/clip removal if applicable, bladder/bowel care, progressive activity, feeding and contraception. Resume driving/heavy activity when recovered and able to perform safely, with local/insurance requirements met.
  • Offer a debrief after an emergency operation and record the uterine incision, complications and implications for future pregnancy.

Follow-up: when and what to review

WhenAction / responsible service
Before discharge
Provide the wound/suture or catheter appointment if required, prescription stop dates and contact details.
Early home/postnatal contact and week 6
Assess wound, bleeding, pain, mobility, feeding and emotional recovery; bring forward review for complications.

Return urgently

  • Fever, wound redness/discharge/opening, worsening abdominal pain, heavy bleeding, urinary retention, dyspnoea/chest pain or leg swelling requires urgent review.
  • If a prescribed opioid causes maternal excessive sedation or the baby becomes drowsy, breathless or feeds poorly, seek urgent advice.

Open the complete discharge checklist →

Sources for this plan:
NICE · NG192checkedNICE · NG194, recommendationscheckedIndia MoHFW / NHM · LaQshya district-hospital SOP, linked editioncheckedWHO · 2022 official recommendation summarycheckedMédecins Sans Frontières · Current online monographcheckedMédecins Sans Frontières · Current online monographchecked
Follow-up: Wound review; next-pregnancy birth-mode counselling · Sources: NICE, NICE, NICE, India MoHFW / NHM, WHO, Médecins Sans Frontières, Médecins Sans Frontières, RCOG, NICE
NICE · NG235 (replaces CG190); updates Nov 2025 water birth, Jun 2025 fluid balance/bladder care/hyponatraemia, Jun 2026 vitamin K deficiency bleeding prevention reintroducedcheckedNICE · NG192checkedNICE · NG194, recommendationscheckedIndia MoHFW / NHM · LaQshya district-hospital SOP, linked editioncheckedWHO · 2022 official recommendation summarycheckedMédecins Sans Frontières · Current online monographcheckedMédecins Sans Frontières · Current online monographcheckedRCOG · Current public recovery informationcheckedNICE · CG50, recommendationschecked